HomeMy WebLinkAbout158094 (5) ? i59ôq '
CITY OF GLENDALE
PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ 85301 SPECIAL INSPECTION CERTIFICATE
623.930.2800
www.GlendaleAZ.com STRUCTURAL
OWNER'S NOTIFICATION OF SPECIAL INSPECTION
To be completed and signed by the Owner before a building permit is issued
In accordance with Sections 1704 and 1705 of the 2018 International Building Code which uir s t at certain construction work be placed under inspection
of a registered design professional.I,as owner/legal agent,do hereby certify that I have r ained f Z.,: ) 1\,` Lltt. to be
responsible for the special inspections on this project. (Registered Design Professional/Firm-please print)
Owner's name: �J F]''F✓ O1��1 1�1,S 0)\_t Owner's Signature: Date: r-1. 2-Li. ZO
PROJECT NAME: REG ERED DESIGN PROFESSIONAL/FIRM NAME:
C
PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
{—1 L 4. T I 1�1. l01 - 14 z.5 z-s F= . AA1-2-:D kJA 'l i -cm Lars-C-: C;,2. #Dz u
CAL-w L-: ,-Z 3O, P Al S 5 b1�v
COG PROJECT NUMBER: 231199 COG PERMIT NUMBER: /5 6 4 7 y
CERTIFICATE OF RESPONSIBILITY CERTIFICATE OF COMPLIANCE
To be filled in and signed by the professional in charge of Special Inspections To be filled in and signed by the professional in charge of Special In •f'ons
before a building permit is issued. before a certificate of occupancy is issued. •
��, ,j•:%r��
As registered design professional in I certify that,to the best of my , A r
charge of special inspections of the knowledge,the requirements of the
above named project,I certify that I d ;. 2018 International Building Code 71 p
am familiar with the design of theF r and the approved plans and ,r� 29371
project and hereby assume full //V
� �' r�G specifications have been complied , FREDER1CK J. cresponsibility for carrying out the r ?t 29371 c with,insofar as the portion of the NOELKE
KE
required special inspections in Ida FREDERICK J. work requiring special inspection -�, Z / 5
accordance with Sections 1704 and NOELKE under Section 1704 and 1705 is �j� '�
1705 of the 2018 International fit► ,6, concerned.A guarantee that the '1it"r Ct) I'-1
Building Code. �`SNE� f contractor necessarily constructed fit��Yh
• �'/ the building in full accordance with
"rvr►jV the plans and specifications is
neither intended nor implied.
(Seal.Signature,and Date) (Seal,Signature,and Date)
SPECIAL INSPECTOR QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER(1704.2.1): DATE:
WORK WHICH REQUIRES SPECIAL INSPECTION QUALIFIED SPECIAL INSPECTOR INDIVIDUAL OR FIRM
• CONCRETE CONSTRUCTION/REINFORCING STEEL/POST-TENSION(1705.3) U
❑ MASONRY CONSTRUCTION(1705.4)
❑ WOOD CONSTRUCTION(1705.5)
• STEEL CONSTRUCTION(1705.2&MSC 360) LtL.- LA 1"+sue 3C
❑ SOILS(1705.6)
• FOUNDATIONS(1705.7,1705.8&1705.9) 2 U l_ 14 CA•4 1 O •
NI SPECIAL CASES:POST-INSTALLED(EPDXY/EXPANSION)ANCHORS(1705.1.1) ?2-4.4UL_ L✓A t i O
❑ SEISMIC RESISTANCE(1705.12)
❑ SPRAYED FIRE-RESISTANT MATERIALS(1705.14)
❑ EXTERIOR INSULATION AND FINISH SYSTEMS(EIFS)(1705.16)
❑ STORAGE RACKS(1705.12.7)
❑ OTHER:
FORM EFFECTIVE 04/26/2019 POST AT JOB SITE WITH PERMIT
pissogq,
FOI[ ; r RI Q. ` ` .
bn1 DATE JOB NO.
2525 E.Arizona Biltmore Circle, D-240 Z
Phoenix,Arizona 85016 ^PROJECT
bakkum I lke
ng S/N r Phone 602.955.9200 Sa^�
consull tting �'
structural engineers Fax 602.955.9201 �ocATRx
( - I5i Ai . 6 (S7-.4 \6
www . bakkumnoelke . com CONTRACTOR
WATNER IMP • M AM
17( s n.� . 6*( ST ,1 tc_ PM
PRESENT AT SITE
-7�rA.el)41. C I A �'L- v £ f?...
THE FOLLOMANG WAS NOTED
> 12-,'_V(et c) LA.) L t S FOR. .o L Ut-r^-) /les ff:Pt
4-t-i_ r (AD 5 4p'— T P
t",(N6I5 0/1-7G 3 3( "Z3
>
•
((UREii1r
NOELKE • o
d oe 5/23723,/• `
'9,Q S1 ned•••*: P.
�ZONA, U
COPIES TO
SIGNED
:1 k rirLD REPO1L i�
,, i,
, 1 n .,' ,
UATC, , 17 23 400 110.
2525 E.Arizona Biltmore Circle, D-240
bakkum noelke Phoenix,Arizona 85016 PRO.�ECT
consulting Phone 602,955,9200 It . C / d` . . i . •=1.1L-e
structural engineers Fax 602.955.9201 tOCATRON
)74- j 1,1. aI AV .
www . bakkumnoelke . com CONTRACTOR oMHER
Q i L Q L( ,
KA1HER TEMP
4► AM
) lei-As) i-J... epit:--1:- AVE--; • ot PH
PRESENT AT SITE
Ca LI.F:'1-11---DA°3 t_. _ ., - i il,..\17_ 555-0 e) c)‘,41 1---1F,„,,,,:rz- .
THE FOLLOWING WAS NOTED
> ;P__ ___1/4 i F--- i 1 O )i 044T 1 0- . E. ` a / -—cf ..
41.,....tc;) r.-.2 1 Lri F_> 1 t--.1 401 '= :. Po - ice ,
� � �iEi I rk;: �Lie."Lie." , - � �i�.r�G r-
.L..___
oii.,/....4-4-( ,ll.‘,..e..4,45 c,,c.---r-ETD 3 - 3) - 2-,3 .
..,,,,,/
7.,..-- ,-.4..tr,,,t;„„\:.,,,,,.„.,,,,-,..-
/.7' to
,,,
U 283
FRED R71ICK J
o NOELKE
-\,.,....,,,,,,,,..??...N...:. i 1 .. ,
,/
COPIES TO
SIGNED 0 w